Stories from the trauma bay

Monday, 12 February 2018

It should come as no surprise that most of my patients, well over 90%, come in to my trauma bay alive and leave the hospital the same way. Don't worry, I'm not patting myself on the back here. It isn't because I'm some sort of spectacular trauma surgeon, but rather because most of these people are just not critically injured. The ones who are critically injured but still survive are what I consider the Good Saves, the ones I occasionally share with you good people. Rarer than this (luckily) are folks that come in dead and stay dead. Fortunately very few people come in alive and leave via the morgue. I sometimes share those stories too.

But the most unusual type of patients, the fleetingly rare ones, are the patients who come in dead and leave alive. Those are the patients whom we as a trauma team consider not just a Good Save, but a Great Save. They are the ones that stick in our memory, the ones we talk about for years to come when swapping war stories and trying to one-up each other. They are the Holy Grail of trauma, each one a once-or-twice-in-a-career event.

And I almost had one of those. Almost.

Dale (not his real name™) was one of those rare stabbing victims that was not brought in at 2 AM. Somehow he had managed to get stabbed at 7:30 in the evening when most people are either eating or getting ready for bed (I guess . . . at least that's what I am usually doing at that time). I haven't the slightest idea what Dale was doing or who stabbed him, but whoever it was wanted Dale dead. He was called in as a code-in-progress, meaning his heart had already stopped en route. When the medics got him to me about 30 minutes after he was stabbed, they looked a bit frantic and completely exhausted.

"Hey Doc, (pant pant) this is Dale. He's 20-ish, (huff puff), one stab wound to the right upper chest. Huge amount of (puff puff) blood loss on the scene. He's been down for about 30 minutes. We couldn't get an IV on him but we got him (puff puff) intubated."

One three-second glance at Dale told me two very important things: 1) Dale had seemingly exsanguinated from a single stab wound to the right upper chest, and 2) Dale was dead. He had no pulse (meaning his heart was either not beating or not beating hard enough to generate a blood pressure), and his pupils were both 4 mm and non-reactive, meaning his brain was critically deprived of oxygen. But in addition to all that, Dale was also cold. Very cold. His core temperature was about 32° C (about 90° F), but when we put him on the cardiac monitor he still had some cardiac activity (a condition known as pulseless electrical activity).

His heart was trying to beat, it just didn't have any blood to pump.

The easy thing to do in this situation would have been to call the code and pronounce Dale dead. Because he was dead. However, I chose not to do the easy thing for two very good reasons:

Perhaps with some oxygen-carrying capacity (read: blood) Dale could be revived (however unlikely that may be), and

As nurses were getting a couple of large-bore IV's started, an assistant was inserting a chest tube into his right chest which yielded very little blood, which meant he had bled out into the outside world (as the medic had indicated), not into his chest. We continued doing CPR and very quickly squeezed two warmed units of blood into him, and immediately afterwards I heart someone yell something that gave me significant pause:

"I GOT A PULSE HERE!"

Somehow, Dale now had a measurable blood pressure. And with that blood pressure he now resumed bleeding torrentially from his stab wound, which was obviously a lacerated subclavian artery. SHITSHITSHITSHITSHIT This is one of the most difficult injuries to repair, as the approach is extraordinarily complex. So I did the only thing I could do in that moment: I stuck my finger in the hole.

This was extremely effective at controlling the bleeding while we continued transfusing him, but it is also extremely temporary. I shouted for the operating theatre to get ready for us, because the only thing that could save Dale's life was a sternotomy.

One very large question remained, however: was his brain already cooked? His brain had been deprived of oxygen for at least 45 minutes, but I had no time to find out just then. That would have to wait until either A) I got the bleeding stopped or B) he was really most sincerely dead.

By some minor miracle Dale's blood pressure held as we wheeled him to theatre, my finger remaining firmly planted in the hole the entire time as I dodged door frames and wall corners. Once in theatre I made a quick 1-second finger switch with an assistant so I could scrub. Ten minutes later I was sawing through Dale's sternum, and his heart was staring me in the face, pumping away.

Not actually Dale's heart

I got control of his brachiocephalic artery first, then I extended the incision across his right upper chest towards the entrance wound. I continued dissecting the artery distally until I got to the point where his subclavian artery split from his common carotid artery. Finally I had proximal control. Unfortunately that was only half the battle, and even more unfortunately it was the easy half. Now I had to get distal control, which was a much more difficult prospect.

The dissection towards the wound continued, my assistant's finger still plugging the hole. To get access to the injury, however, I had to remove the middle section of the clavicle (and my assistant's by-now very cramped finger). Once this was done the injury finally came into view as it was audibly bleeding. Yes, I could actually hear the blood rushing out. Somehow the knife had missed the subclavian vein and had hit only the subclavian artery. With the artery now clamped both proximal and distal to the injury, I carefully placed a few sutures in the artery, trying to stop the hæmorrhage but still maintain some flow into the right arm. My main objective, however, was to stop the bleeding, not to save the arm, which was a distant secondary goal (life over limb).

Just like that, the bleeding stopped. Voilà! Success! I took a few minutes to exchange high fives all around (not really) before thoroughly checking for other injuries (there were none) and closing. But as I closed him that one big question still hung over everyone's head:

THE BRAIN. What was the status of Dale's brain? I had no way to predict how his brain would react to prolonged oxygen deprivation before we had been able to get his heart restarted.

Over the next two days his blood pressure stabilised, he stopped bleeding, and he actually began to open his eyes. On the third day I was stunned and even cautiously optimistic to find that he even seemed to follow some simple commands.

A Great Save! Huzzah! We did it!

The optimism wouldn't last.

Now that he was stable we were finally able to get a CT scan of his brain, and finally the devastation of his brain injury became apparent. He had widespread ischæmic damage to his entire cerebellum and various large portions of his cerebrum with extensive œdema to the point where his brain was starting to push his brainstem down into his foramen magnum (so-called transtentorial herniation).

There was but one option left and it was a drastic and rather terrible one. But I had no choice because Dale was in immediate danger of dying. Again. In a last-ditch effort to save him, one of my neurosurgery colleagues took him back to theatre to remove a portion of his skull to give his brain space to swell and allow the herniation to improve.

It didn't work. Two days later he was completely unresponsive, his pupils were both blown, he had lost his cough, gag, and corneal reflexes, and both an apnœa study and brain flow study confirmed that he was brain dead.

GOD DAMN IT.

I went through the entire gamut of emotions during Dale's course, from frustration to elation, worry to optimism, fear to dejection. Just when I thought Dale was dead, he came back, and just when I thought he would make it, he didn't.

The entire time I worked on Dale, every single moment, my Inner Pessimist kept reminding me that he had a 99% chance of dying. But goddammit that also meant he had a 1% chance of surviving. While that isn't very high (obviously), it also wasn't zero.

Wednesday, 7 February 2018

NOTE: THIS POST WAS WRITTEN SOMEWHERE BETWEEN 0 AND 12 MONTHS AGO DURING FLU SEASON HERE. NO, I WILL NOT TELL YOU WHERE "HERE", BUT I WILL TELL YOU THAT FLU SEASON IS DURING THE WINTER HERE, JUST LIKE IT IS WHEREVER THE HELL YOU LIVE.
I'm a healthy guy in my {redacted}decade of life. I've had very few serious maladies in my life, the most dangerous of which (so far) was appendicitis in my 20s. I don't take any prescription medication, I have no allergies, and I have no chronic health problems, so I have very little reason to complain about my health.

And now I have the goddamned flu.

Let me clarify something quite clearly: I do not have a cold. Yes, I have nasal congestion, a nasty productive cough, and a headache. But I do not have a cold. I also have generalised body aches and a high fever of 39.6° (that's 103.3° Fahrenheit for you Americans out there). Yeah . . . this is not a cold. I have the fucking flu, and it sucks. It sucks a lot. I've had dozens of colds in my life, some of them worse than others, but none of them was ever bad enough to land me in bed. I have spent exactly 0 days of my adult life in bed with a cold.

Until now. I spent the first three days of last week in bed with this goddamned plague.

It started off innocently enough while I was on call, just a mild cough and some congestion. I figured it was just another cold, because my wife recently got over a cold and everyone around me seems to be sick with something. The next day, however, I felt like I had been run over by a truck, and I chalked it up to it being the day after another tough trauma call with no sleep. I managed to trudge through that day, but when I woke up the next morning that truck that had hit me had turned into a freight train.

My body temperature that morning: 39.6.

That day the mild cough turned into a constant, hacking cough, and I would have been amazed at the stuff my lungs were able to produce if I had been able to muster the energy to become amazed. Ibuprofen was able to bring my temperature down to the point where it didn't feel like my head was ready to explode, and oxymetazoline gave me the ability to breathe for several hours. Realising that this was not just a cold, I quarantined myself in a spare bedroom (Mrs. Bastard's orders), and Mrs. Bastard was vigilant in keeping the Little Bastards far, far away from me.

And for the first time in my adult life, I spent all day in bed.

The next morning my temperature was still 39.5. I discovered I was scheduled to be back on trauma call the next day, but I was absolutely unwilling to expose any of my prospective patients (and coworkers) to this scourge. Fortunately I was able to switch call with a colleague. Again, all day in bed.

I will reiterate that I am a healthy guy and I tend to get over colds quickly, usually within a day or two, so I expected to be better by day three. But that morning my temperature was still 38.5. The coughing had not improved at all, my head was still pounding, and I could barely breathe. This is not just a cold, dummy, I kept reminding myself. There were several times when I considered going to the hospital, but I wasn't quite there.

It was three days in bed and three more days after that before I felt able to go to work. I wore a surgical mask in the hospital for the next several days to avoid exposing patients. I wore gloves and washed my hands religiously. But just walking through the halls seemed to take my breath away. I even tried taking the stairs once - big mistake.

It has now been two full weeks since I felt my first symptoms, and I am finally very close to 100%. I still have a very occasional cough, but I haven't taken any medicine in well over a week.

Now I'm sure many of you are wondering one very important thing: did I get a flu shot? Yes, you know I got a flu shot.

So the flu shot failed! It's worthless! Why bother!
This seems to be one of several arguments I have seen people make against getting a flu shot:

It is ineffective.

The strains in the flu shot are nothing more than a guess.

The flu shot gave me the flu.

I've never gotten a flu shot, and I've never gotten the flu.

Why bother getting a flu shot? It's just the flu.

I could give you the short version and just say that all those arguments are ridiculous bullshit. However, that would be the lazy way out and would convince exactly no one, and since I'm no longer sick, I can no longer use that excuse. So instead I shall address all these issues in order:

Yes, the flu shot failed to prevent me from getting the flu. Yes, the flu shot is the least effective vaccine in existence. However, the flu shot is not ineffective, as the efficacy averages around 45% (though it may be as low as 10% this year). However, even if the efficacy is 45%, that is literally an infinite times more effective than not getting the flu shot, which would have an efficacy of exactly ZERO PERCENT. Not getting a flu shot is a guarantee not to be protected, but getting a flu shot may protect you. That should be a no-brainer.

The strains in each year's flu shot are an educated guess based on worldwide surveillance. It isn't like the scientists throw a dart against a dart board.

It is a 100% biological impossibility to get the flu from a flu shot (I'm not talking about the nasal mist here). It is an inactivated vaccine, which means the viruses in it are dead and are thus NOT capable of infecting you. At all. EVER. No one in the history of flu shots has ever gotten the flu from the shot. The "flu" you think you got was your body's immune response to the vaccine, and it lasts for a day or two. That is NOT the flu. If you did get the flu immediately after getting the flu shot, you already had it when you got the shot since influenza has an incubation period of 1-4 days.

If you've never gotten the flu despite never getting a flu shot, that doesn't make you smart or correct, it just makes you lucky. If you survive a hurricane despite staying in your house, that doesn't make you smart for staying, it makes you a complete fucking idiot for staying, just a lucky complete fucking idiot.

"Just the flu" infected nearly 1/3 of the planet in 1918 and killed about 50 million people that year. Remember the H1N1 "bird flu" from a few years ago? Yeah, that was the same H1N1 that caused the Spanish flu epidemic. "Just the flu" still kills hundreds of thousands of people each year worldwide, and up to 50,000 people in the US each year, most of whom are either very old or very young. The flu is not a cold, and the common cold is not the flu. There is no such thing as "just the flu". The flu kills.

There are two other major details that many people don't seem to know:

Sunday, 28 January 2018

I recently got into it with a TV writer on Twitter. Well, that isn't exactly true. What really happened is that she said something wholly offensive and completely bullshit, I called her out, and she responded with some almost-worse backpeddling bullshit which I couldn't see because she simultaneously blocked me like a fucking coward. What she actually said that incensed me I'll get back to (I promise), but who she is is somewhat more important.

The writer in question is Amy Holden Jones, who happens to be the screenwriter for "Indecent Proposal" and "Beethoven". She also is the creator of the new Fox television series "The Resident", the newest in a series of unfortunate medical dramas that have splatted on our televisions for the past several decades. I call them unfortunate because they all invariably fall into the abyss of Bullshit-In-The-Name-Of-Drama rather than attempt even a modicum of veracity. It is the reason I could never watch House MD for more than five minutes without turning it off - there would always be some kind of "OH COME ON!" moment that was so full of ridiculousness that I simply could not tolerate it any further.

So after my nasty little interaction with the creator of The Resident, I decided to sit down and watch the first episode, which Ms. Jones also happens to have written. I'm not the first doctor to do this, nor (I'm sure) will I be the last, but after seeing what Ms. Jones had to say about doctors (yes, I WILL get to that, I promise), I wanted to see how she wrote about them - what they say, how they act, etc. Keep in mind I had no idea what the show was about when I sat down, though I suspected it was about a resident (ie student doctor, junior doctor, etc). Obviously. I'll be writing this live as I watch, something I've never done before.

Strap yourselves in. I don't expect this to be a smooth ride.

The show starts in the operating theatre during what appears to be an open appendectomy, soft classical music playing in the background. At least the lights are on. So far so good. Someone (a student? A resident? THE resident? I have no idea) mentions it's her first surgery with this surgeon (so what?), and someone else (a nurse carrying a clipboard for some reason?) says she has to get a picture of the occasion. What? Weird. She summons the anaesthesiologist from around the curtain (WHAT?), which prompts the surgeon to tell them "That is totally inappropriate". I found this line startlingly accurate, because I expected him to pose along with them and yeah, that's completely inappropriate. "Aw, we're just having fun!" the anaesthesiologist replies, which of course is the first "OH, COME ON!" moment of the episode, and we're only 30 seconds in, people. The bullshit gets instantly worse when the patient wakes up, opens his eyes, and starts to move while they're all busy taking selfies.

OH, COME ON!

The anaesthesiologist runs back, but the surgeon, who is inexplicably still holding a scalpel in his hand (what does he expect to be doing with that at that point during the surgery?), nicks something right on the surface which starts squirting blood onto his face and gown. OH, COME ON! The bullshit gets EVEN DEEPER when this senior surgeon (who turns out to be the Chief of Surgery, by the way) freezes, apparently lost for ideas (like, you know, stop the fucking bleeding). The nurse with the clipboard says "YOU HAVE TO CLAMP SOMETHING!" because no one else has thought of clamping something, and apparently she somehow knows that the patient has lost two litres of blood already (in literally 20 seconds) and the surgeon has no idea what to do. Exactly one second later (yes, really) the anaesthesiologist announces the patient has lost his pulse and is in PEA arrest, (OH, COME ON!) and the surgeon starts CPR - on his abdomen.

OH, COME ON!

"CPR isn't going to put all that blood back into his body", the clipboarded nurse says sadly as the surgeon performs his worthless abdominal compressions. Exactly seventeen seconds later (yes, really) the anaesthesiologist says "It's no use", and the surgeon stops.

DRAMA.

"He is so dead!" says the dramatic nurse dramatically.

HAHAHAHAHAHAHA! No seriously, the actual line that Holden wrote for this nurse is "He is so dead." HAHAHAHAHA! DRAMA.

Everyone dramatically takes off their masks and gloves, and after a few glances across the room, the surgeon announces, "Well I think we can all agree it was the misdosed sevo {sevoflurane, an anaesthesia drug}".

WHAT?? Sure surgeons try to blame anaesthesia all the time (mostly joking), but not right in front of everyone! Oh don't worry, it gets worse.

The anaesthesiologist tries to argue it wasn't his fault because the surgeon had the scalpel in the field (true), but the surgeon instantly reminds him of another patient whose oropharynx he "ripped through" on a routine intubation, and he had covered for him then.

WHAT???!? What the ever living fuck is this supposed to be? Doctors don't cover up other doctors mistakes, especially in front of the entire operating team. We have morbidity and mortality conferences where we actively discuss mistakes, both serious and common, and everyone learns from them so that mistake doesn't get made again. We don't do quid pro quo where if I fuck up you cover for me, so that gives you a Get Out Of Fuckup Free card the next time you make a fatal error. This is such egregious bullshit I am absolutely livid and frankly shocked that this made it onto television.

IT GETS WORSE.As the members of the surgery team all discuss the situation, the nurse says "We're all on the same team here . . . right?", with the clear implication that they all need to cover for each other. Someone else says, "Maybe he had a heart attack?" WHAT??? The surgeon shuffles away as the anaesthesiologist looks at the chart and tremulously says "Yes, there's . . . some family history of heart disease." "Yes," the nurse says definitively, "his left main {coronary artery} clogged. Sudden cardiac event."

That's right, we are that chock full of some of the most putrid, absurd, repugnant blather I've ever witnessed on television, and we're only 4-and-a-half minutes into this travesty.

And we STILL haven't even met The Resident yet.

If you're worried the bullshit starts to lessen as the episode progresses, you're in for a huge disappointment. In the next scene Devon (The Resident) meets Conrad, his senior resident, who quite authoritatively tells Devon The Resident that he has to do everything he says or he can remove him from the program (uh, no you can't - you're both residents). If that weren't bad enough, Conrad gives Devon The Resident a code blue on his very first day as a doctor. Uh, no. And then Connor slaps Devon's cheat sheet away when Devon tries to reference it. You know, so he doesn't kill the patient.

OH, COME ON!

The one bit of truth in this episode comes in the next scene when Conrad chastises The Resident on continuing that code for too long, which ends up regaining the patient's heartbeat but leaves her brain dead (Jahi McMath, anyone?). "All we want to do is help our patients, but what they don't teach us in medical school is there are so many ways to do harm", Conrad philosophises.

Ouch. Very true, but very ouch.

But just when I thought the bullshit was over, it jumps right back into it with a wealthy philanthropist awaiting robotic prostate surgery which is to be done by a visiting second year resident (WHAT??), though the philanthropist wants The Surgeon to do it even though he's never even touched the robot before, not to mention the fact that prostatectomies are actually be done by urologists, not general surgeons. This is a most basic fact-checking failure that anyone in the medical field, even the radiation oncologist who created the show with Holden Jones, should have picked up.

But then Holden Jones finally shows her true colours, her agenda behind this absurdity. As The Resident worries over his brain dead patient's future and if there will be an investigation, a nurse (who happens to be Conrad's ex-girlfriend - DRAMA) tells him the hospital will probably give him a medal because they will bill thousands of dollars every day she's in the ICU. Because, she explains, "It's a huge payday for them. Medicine isn't practiced by saints . . . it's a business."

IRE RISING

If that weren't bad enough, the nurse goes on to tell The Resident of a surgical error that killed her mother after a routine test gone awry. "This happens all the time, Devon. Medical error is the third leading cause of death in the United States after cancer and heart disease."

Ok, fuck you Amy Holden Jones. FUCK YOU.

I'd like to address this "third-leading cause of death" myth before I go further. I see anti-medicine people use this "statistic" all the time, always in an attempt to make doctors in general look bad, and it drives me fucking bonkers. Fortunately I don't really have to address it fully, because Dr. David Gorski, a surgical oncologist and prolific medical blogger, has done so already. Long story short: no, medical error is NOT the third-leading cause of death, not by a long shot. The only reason Holden Jones could have possibly included this line in the show is to make doctors look bad. That is the only reason.

I had a very strong feeling that Holden Jones had an anti-doctor agenda when I started watching, but I never in a million years thought she would just put it right out there on a silver fucking platter. The reason I had that feeling was the tweet I alluded to previously. This one:

It's all there in black and white, a very real and very libelous declaration that cancer doctors are nothing but money-hungry ghouls who are paid kickbacks (which are illegal) to prescribe toxic chemotherapy to patients, even when it is no longer indicated.

ARE. YOU. FUCKING. KIDDING. ME.

Holden Jones tried to defend this indefensible statement by giving an example of one unscrupulous cancer doctor who made money by giving chemo to patients who did not need it. Yeah, that guy was an immoral asshole who abused patients and deserves every minute in prison that he got. But one example does not describe all the other oncologists around the world who chose that specialty knowing they would be dealing with some of the sickest patients, who have dedicated their lives to a specialty that can help many but save few.

On behalf of oncologists everywhere, I called her out on her bullshit:

No, oncologists are NOT paid kickbacks for giving chemo, nor are they money-hungry ghouls who give toxic drugs to sick cancer patients just to line their own pockets. This tweet is disgusting, offensive, and embarrassingly wrong. Delete it. @aholdenj@FOXTVhttps://t.co/UAnX4tE93Z

Unsurprisingly she did not seem to take this well, as she immediately blocked me. She did, however, respond to me before doing so (not that I could actually see it):

Unclear? No, Ms. Holden Jones, it was not unclear in the slightest. What you said is a vile lie and it exposed your true motive behind your writing. You made your anti-doctor sentiment more than clear through your tweets, but you managed to crystalise them very nicely with your bullshit script on your bullshit show.

If you're looking for some risible anti-doctor soap opera twaddle on which to waste an hour a week, look no further than The Resident (apparently there are more episodes to come). But if you'd like an interesting new television series that won't make you want to punch your television, set it on fire, bash it with a sledgehammer, throw it in a wood chipper, and never watch it again, try Black Mirror, Stranger Things, or Star Trek: Discovery. Or get into Game of Thrones. You still have at least a year before the final season starts.

And if you're wondering, no I will not be watching episode two.EDIT: Let me make one thing abundantly clear here. I am not upset that the show features typical television-medical-drama-bullshit. I was not looking for a scientifically accurate program, and I certainly did not find one. What pissed me off is the anti-doctor rhetoric that was rampant throughout this episode (and that apparently features prominently in another episode, as was told to me by a reader).

Wednesday, 24 January 2018

I'm sick. Yeah, I have a goddamned cold and I'm fucking sick. And when I get sick I get grouchy. Therefore I'm pissed off and generally feeling ranty. I don't think I'll have a lot cohesive to say here, so this may be a bit of an oddball post. But whatever, I'm the one who's sick so fuck it. Let's just get on with it.

Right.

I'm fucking tired of "organic". I'm tired of people who sell organic food thinking they're somehow better, and I'm tired of people who buy organic food thinking it's healthier. You aren't, and it isn't. How the fuck did organic become a thing? Organic does NOT mean "pesticide-free" (yes, "organic" farms still use pesticides), it actually just refers to any compound that contains carbon. But now it means pretentious expensive bullshit.

And I'm tired of natural. Yeah, pretty much anything that calls itself "natural". There's natural shampoo, natural dog food, natural dish soap. You know what's natural? Fucking everything. Everything on this earth comes from this earth (except perhaps meteorites). And why do so many people think natural is good? Hurricanes and tornadoes are natural. Pit vipers are natural. Deadly nightshade is natural. Arsenic is fucking natural. Nature is constantly trying to kill you, yet you think natural is good? In case you don't believe me, check out this picture from The Naked Label, a bullshit website run by a "certified nutritionist" (a certification which does not actually exist):

What's the problem, you may ask? That mushroom is Amanita muscaria, and it is fucking poisonous. Yeah, I think my bolognese is better than that poisonous fungus that nature made in order to kill me.

And I'm tired of companies jumping on the non-GMO fear-mongering bandwagon, advertising anything and everything as non-GMO. I can't tell you how many products I've seen labelled as "non-GMO verified" when they don't contain any ingredients that have ever been genetically modified. For example, you can buy non-GMO pickles:

God damn it, there is no such thing as a GMO cucumber! And if that wasn't bad enough, there is also non-GMO water. Yes, really:

You can also buy non-GMO salt:

For fuck's sake, do these fucking companies even realise what the "G" in "GMO" stands for? Genetically. GENES! Water and salt do NOT have genes! And do I really have to state what the "O" stands for? Is water a fucking organism?

Oh, and while I'm on the subject, I'm fucking sick of hearing about gluten. Sure, gluten is very bad for you if you have cœliac disease. But gluten is otherwise absolutely fine. It's just a protein found in wheat, rye, and barley, and it is not dangerous or unhealthful. But way too many people seem to think gluten is the cause of all their problems, and they simply must get it out of their diet. Just walk through a grocery store these days to see all the new "gluten-free options". Like these:

Do we see the problem here? Exactly, THERE IS NO GLUTEN IN CORN OR RICE. And there is most definitely no gluten in fucking beef. Oh, and go back up to the picture of the bottle of water up there. In addition to being non-GMO water, it's also gluten-free water. FUCKING GLUTEN FREE WATER. All these companies are doing is jumping on the very lucrative bandwagon, and it pisses me off.

And I'm tired of hearing about "real food". Don't tell me to eat real food and avoid fake food. Real food is anything with any nutritional value that I put in my mouth, chew, swallow, and later shit out. Don't tell me my Oreos are fake food, because they aren't. They contain actual food products that actually contain calories and a token tiny amount of vitamins and minerals thrown in for good measure. You know what fake food is? The bowl of plastic fruit my grandparents had on their coffee table that fooled me at least twice (that plastic apple looked really real). I know Oreos are not good for me, which is why I eat them only rarely. But they most certainly are not fake. I have no idea why "junk food" has been replaced by "fake food". Was someone offended by the term "junk food"?

And then there are the various waters. There is hydrogen water, alkaline water, pH-balanced water, supercharged water, kangen water, and all other kinds of bullshit water. Yeah, it's all bullshit. If you want water (and yes, you do), there is an unending stream of it that comes out of your tap at any time. It's pure, clean, safe, and costs about 0.01% (or less) of any of the bottled water you can buy. If your municipal water supply tastes too minerally for your taste, buy a filter. Bottled water just pisses me off almost as much as pre-peeled oranges repackaged in plastic.

I think that's about enough ranting for one day. There's only but so much ire my body can take per day. Besides, I think it's about time to redose my various cold medicines even though they don't fucking work.

And don't even get me started on quinoa and kale. Because fuck that shit.

Wednesday, 17 January 2018

Of all the stupid clichés about communication (Communication is key, communication is a two-way street, blah blah blah etc etc), my least favourite is "It isn't what you say but how you say it". And before anyone says anything, yes I understand the irony of saying "blah blah blah" while complaining about communication. Whatever. Fuck it. Anyway, don't misunderstand me - how you say something is indeed extremely important. But really, I don't care what the cliché says, because what you say is infinitely more important.

Don't believe me? Then let me tell you a short yet instructive story that should illustrate my point rather emphatically.

Bryan (not his real name™) was brought to my trauma bay one fine Sunday afternoon having been stabbed by his girlfriend about 10 times following an altercation. I didn't ask about the details, because really, who the fuck wants to know why anyone would stab someone 10 times.

"Hey there Doc, we have Bryan here. He was stabbed 9 or 10 times, we lost count. Heh heh (no one laughed at his stupid attempt at a joke). The worst one is the left chest. Oh, and the neck. Heh heh (again, no laughter). All the others look pretty superficial. Bleeding is controlled, and he's been stable for us the whole time."

The medics seemed to have gone through two or three boxes of gauze of various shapes and sizes while dressing all of Bryan's myriad wounds. Fortunately Bryan's girlfriend's knowledge of vital anatomy was on par with Donald Trump's knowledge of, well, anything, because there were no life-threatening injuries. A quick X-ray of his chest showed no penetration of the knife into the thoracic cavity, and on examination of his neck wound the platysma had not been violated. Whew. Still, he had an impressive series of lacerations on his left upper arm, left forearm, left chest, neck, left thigh, and right shoulder, all of which needed to be repaired.

I was obviously going to be busy for a while. Sigh.

After gathering all the various accoutrements required for suturing his approximately 71 cm-worth of lacerations (yes, I counted), I started irrigating each individual wound, followed by cleansing with iodine solution (yes, we still do that). As I was infiltrating the left arm wounds with lidocaine, he started mumbling something to himself. I couldn't understand most of it, but there were a few words here and there that were unmistakable:

At a loss for words, I looked imploringly over at the police officer who was standing right next to me and had been apparently waiting patiently to take Bryan's statement. He returned my quizzical glance, both of us too stunned to speak. But Bryan wasn't done. Not remotely.

I looked back at the police officer who simply smirked, shook his head, and wrote something in his little notebook, which I have to assume was something resembling "HOMICIDAL PSYCHOPATH, DO NOT LET NEAR GIRLFRIEND".

About an hour and 2,401 sutures later (I may be exaggerating slightly), Bryan was all fixed up and ready to go. I briefly went to check on another patient, and when I came back a few minutes later to give Bryan his discharge instructions ("1. Come see me in a week to get your sutures out, 2. Apply antibiotic ointment 2-3 times a day, 3) Don't kill your girlfriend"), he had a very fancy set of matching stainless steel bracelets on his wrists. I tried to question one of the other police officers who had come to take Bryan away, but all he would tell me was that "the official story had changed".

I decided to accept that and move on.

Had Bryan actually done something that warranted a moderate bloodletting? I don't know, and I will likely never find out. And to be perfectly honest, it doesn't matter one bit, because my job is to fix holes. Holes I can fix. People . . . not so much.

Regardless, what Bryan said was bad enough, and the way he said it made his situation even worse. But Bryan taught me a very important lesson: it isn't only what you say and how you say it, it's also to whom you say it.

Tuesday, 9 January 2018

I know I risk angering the Call Gods by saying this, but my trauma game has been rather slow lately. I've had very few blog-worthy stories of late, and the last thing I want to do is post a "Oops, no story this week" filler bullshit. So instead I've decided to continue a tradition from January 2015, or at least what I intended to become a tradition but instead got lost amongst the drunken idiot stories: CONFESSIONS.

Yes, I believe the best way to start a new year is not by making yet another resolution that you know will be broken by January 2 (no, you will NOT go to the gym every single day), but rather by confessing sins and starting the year clean.

So here goes. The Official DocBastard Annual Confessional continues.

Though I am a die-hard heavy metal and prog rock fan, I confess to thoroughly enjoying the song "I Want It That Way" by the Backstreet Boys. I have tried my best NOT to like it, yet I find myself singing along with it every single goddamned time I hear it, most recently this afternoon.

While I'm on the subject of songs I'm embarrassed to like, I also confess that I like "Love Yourself" by Justin Bieber. Fuck me, but that's a clever song. I hate myself for liking it.

Even though the number of followers I have doesn'timpact my self-worth, I really do want more followers on Twitter and more readers here.

I want to meet Andy Wakefield, ostensibly so I can not-so-politely tell him of the irreparable harm he has done to public health, but actually so I can punch him in his stupid fucking lying face.

I hate teaching medical students.

I hate training new surgeons even more.

I plan on retiring from clinical practice in less than 10 years.

I enjoy riling idiots on Twitter and proving them wrong.

I like challenging the Call Gods sometimes and seeing what kind of shitstorm they bring me in retaliation.

I speak to my drunk patients in the same manner I speak to my children.

I hate spam comments here almost as much as spam phone calls at home, and I wish I could round up all the spammers, put them in a small office building, and make them all call and email each other nonstop until they all die.

There have been a few times on call when I wish I could have had a beer.

I drive home drowsy after call regularly. I know it's fairly stupid, though I haven't come anywhere close to falling asleep at the wheel in about 15 years.

I am a big Star Wars fan, and I loved "The Last Jedi". It's probably my favourite Star Wars movie. I'm sure this will anger many die-hard Star Wars fans, so COME AT ME.

Sunday, 31 December 2017

It's that time yet again, ladies and gentleman. Time once again to say goodbye to the raging shitmaelstrom that was 2017, and hello to the brand new year. 2018! The year where everything will suddenly be so much better! This will be the year frauds and mountebanks will cower under the supreme reign of science and evidence, and when incompetent orange quarterwits will no longer be in charge!Ha. Ha. No. We all know that won't fucking happen. But instead of wallowing in pseudoscientific misery, let's instead (as promised) enjoy this rousing interview with my wife, Mrs. Bastard (not her real name™). You asked the questions, and she's graciously answered them. Questions I've deemed too personal have been unreservedly ignored and/or sent to live in the White House with Mr. Trump, because censorship is totally fucking legal (and in fact actively encouraged) in Bastardia. So without further ado, I give you my wife.Please.Ha haha ha. Siiiigh.What's DocBastard's embarrassing secret/s? (from Timethyfx)I don't know. *turns to me* Do you have any? {No. Of fucking course not. I air all my dirty laundry right here.}What is your favorite blog post? (from Casi G)I guess I would have to have read them to be able to answer that. No, actually Doc tells me all of the stories the second he gets back from the hospital, no matter if I'm enjoying my morning coffee or taking a shower or whatever. I get to relive them all personally and in all their gory detail.What is your favorite holiday and why? (from Angel)My favourite time of year is December, as the general population tends to be kinder, more understanding, more patient, and more at peace with each other.What is Doc's "tell" that there is a new story forming? (from Ken Brown)Usually when he gets home, sighs, smiles, and says, "You're not going to believe this one". And then I respond by saying, "That sounds like a blog post!"How stressed is Doc at home about work? (anon)He's most stressed when he's lost a patient that he feels he shouldn't have, or if he has a patient who's very sick and he can't figure out why.What brings tough ole Doc Bastard to tears? (from Nautipirate).I can't think of anything that's brought him to tears. {You're goddamned right there isn't.} Perhaps a spoiled beer. {Nope.} The last piece of lasagne? {Nah.} The end of season 7 of Game of Thrones with a year and a half to wait until season 8? {Ok, you got me there. *sniff* Dammit, I got something in my eye.}How is grocery shopping with the DocBastard? (from Cali)Do we grocery shop together? Have we ever been grocery shopping together? {For the record - YES WE HAVE. God damn it.}Would you want your kids to be Doc Bastard juniors? (from Joan B)Aren't they already DocBastard juniors? But if you're asking if I want them to be doctors, no. NO. NO NO NO NO NO NO.In other words, no.Is Doc any good at carving the turkey? (from tania cadogan)What do you think? Does a bear shit in the woods?Whats the best thing Doc can cook? (from Shark)He makes a mean fresh fettuccini with bolognese.We know what doc thinks of shows like House, but what does Mrs. Bastard think? (from Connor)I think they're largely entertaining, as long as you buy into willful suspension of disbelief. {And can put up with me constantly yelling at the television because they've royally fucked something else up AGAIN. Come on, Hollywood. I'm available for consulting work. Call me.}How did you come to marry Doc? Did he propose on bended knee, did you propose to him, or did you just both decide it was time? (from Cleopatra)He proposed on bended knee. I feel like he should have been on both knees. And he also should have chosen a location that we could go back and visit that wasn't destroyed. {No, I'm NOT TELLING, so don't even ask.}How long have you two been married? (From Not your average housewife)Long enough. {Love you too, dear.} No, it seems like just yesterday. Long enough to put up with each others' idiosyncrasies and even be fond of some of them. Long enough to finish each others' sentences and know what each other is thinking, but not long enough not to discover new things about each other. {Aww, no seriously, I love you too, dear.} What's the best present Doc ever gave you? (Excluding your perfect offspring, of course.) (from RC)My cappuccino machine. And that big green sweater with the giant gold buttons that was probably the most hideous thing I've ever seen. {Really? Come on, I barely knew you then. Are you ever going to let that go?)How do you keep your household running smoothly? Does Doc help with the dishes? (anon)WD40. It keeps everything running smoothly. No, lists, lists, and more lists. Speaking of lists, have you changed that light bulb over the piano yet? It's been TWO YEARS. {No, because it's only been 2 years.} And did you empty the dishwasher? {Yes.}What made you fall in love with Doc, and he with you? (anon)I think there was instant attraction and chemistry, but I don't know what made me fall in love with him. It must have been his charming personality and his wit. {I swear I didn't make that up. Those were her exact words. Honest.} It certainly wasn't his taste in clothes. Or hideous green sweaters with giant gold buttons. {Oh, har dee fucking har har.}Do you have any advice for newly weds/ new parents/just random pieces of good general life advice? (from the small raven)Advice for newlyweds: 1) Don't marry a trauma surgeon. 2) Never go to bed mad at each other. 3) Respect each other. Advice for new parents: 1) Don't throw the baby against the wall. 2) Don't throw the baby against the wall. 3) I mean it, don't throw the baby against the wall. 4) Don't worry, projectile vomit and pee do come out in the laundry and don't leave a stain. Usually.Random good life advice: Be good, and do good. {See why I married her?}What is Doc's favorite dish for you to cook and will you share the recipe? (from Promise)His favourite thing is lasagne. I use the Fanny Farmer recipe. Google it. {She doesn't like to share recipes for some reason. Don't Google it - I've done it for you. Just click the first picture.}We all know that Doc Bastard has a fascination for pulling various things out of rectums. What is the best "removed from rectum" story he's ever told you? I bet it wasn't the one he told US! (from Wednesday)Actually, it is. It's the Coke bottle story, for sure. I think that's one of his first blog posts. And it was his first RFO. Still the best. That was a great story. {Yes, yes it was.}If DocB were an animal (of the non-human sort) what animal would he be? What would you be? What kind of hybrids would the Little Bastards be? (anon)He would be a non-lazy animal. He would be an industrious, cute animal. I think he would be a beaver, because he can whittle things out of wood. I, on the other hand, would be a honey badger. Why? Because honey badger doesn't give a shit. Our hybrid son would be a sloth-hyena because he likes to hang off things and makes way too much noise all the time. Our hybrid daughter would be a unicorn. {Because why the hell not.}Does Doc utilize any of his surgical skills at home? Can he sew a hem? (from OldFoolRN)He uses his surgical skills all the time at home. Let's put it this way - when a hem needs to be sewn or a button needs to be replaced, it's not Mrs. Bastard doing it. I just say, "Daddy Bastard, can you please sew this for me or close this hole in this stuffed animal or replace its arm?" I can also guarantee the button will never fall off again. {For the record, MomBastard taught me to sew when I was about 8, though I do usually use surgical knots which she did not teach me.}If you could magically change Doc's profession, what would you have it be? What type of place would be your dream retirement destination? (from Hippodamia)I would change his profession to personal chef. Because then I would never have to cook again. {What, you think I'd still bring my work home with me?} And he would have better hours. Our dream retirement destination would be someplace where it's 28 degrees {that's Celcius} all year round, people are nice, life isn't so rushed, but has access to all the amenities and culture of a big city. {That place doesn't exist, dear.}What kind of movies do you like and what do you watch together? (from Scott Aylor)I like comedies. {I like sci fi}. I can't remember the last time we watched a movie together and didn't fall asleep. Am I asleep right now? Are we still doing this interview right now? ---There you have it, folks. Another year and another interview wrapped up. I'll see if Mrs. Bastard is up for another interview next year. If she hasn't killed me yet. Maybe I'll have even changed the light bulb over the piano by then.Probably not.Happy New Year!

About Me

I am a trauma and general surgeon at two hospitals in the suburbs of a major metropolitan area. One of the hospitals is in a rather poor suburb, the other is in a very affluent suburb. I see all kinds of crazy shit at both.
Feel free to email me at docbastard1@gmail.com if you have questions, comments, or stories you want me to publish. Yes, I'll give you credit.
Don't be afraid to comment or email me. I appreciate both!